PRK Vision Surgery

Millions of people have had Lasik or PRK surgery to correct poor eyesight.

It's allowed many airline pilots to give up their glasses or contacts, but it's a different story for some military pilots.

Refractive surgery isn't an option for army aviators now, but the procedure is being studied right here at Fort Rucker.

The U.S. Surgeon General will make a final decision on using Lasik and PRK for army aviators after the Fort Rucker study ends in July of 2004.

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What is refractive surgery?

Corneal refractive surgical procedures change the shape of the cornea to correct myopia (near sightedness), hyperopia (far sightedness), and some types of astigmatism (irregular curvature of the cornea). These procedures offer the potential to reduce or eliminate the need for glasses and contact lenses. In most cases, however, these procedures do not correct presbyopia, which is the need to wear glasses for reading after middle age.

What is PRK surgery?

Photorefractive keratectomy (PRK), a type of refractive surgery, is an FDA approved procedure for reshaping the cornea. An excimer laser uses an ultraviolet wavelength to deliver pulses of energy that remove a small disc shaped sliver of the central cornea. To accomplish this treatment, the surface layer of the cornea must also be removed, but it grows back in place within a few days after the surgery.

Is PRK surgery safe?

While this surgery is FDA approved, medical professionals and their associates consider this treatment as experimental as long-term side effects are not yet known. Prior to FDA approval, extensive clinical studies were performed to assess PRK safety and efficacy.

Eighty to 90 percent of people who require glasses for distance vision may be eligible for PRK. It is an effective procedure, with up to 95 percent of treated patients not needing distance glasses to achieve 20/40 vision or better. About 75 percent of patients achieve 20/20 vision. The results may not be quite as good among patients with more extreme forms of myopia, hyperopia or astigmatism.

PRK is a surgical procedure and thus the outcome cannot be guaranteed. Any surgical procedure should be undertaken only after careful consideration of the likelihood of success and consequences of any possible risks or side effects. Thorough professional advice from a qualified eye surgeon or surgeons is required before any eye treatment is undertaken.

Are there side effects to PRK surgery?

Serious complications are extremely rare. Most complications are treatable with medications or further surgery.

The most common complications are:

Infection

Delayed surface healing

Corneal haze and or scarring

Over or undercorrection

The development of astigmatism

Poor or excessive healing response

Immediately after surgery there can be:

Discomfort; the use of bandage contact lenses and medications usually control this.

Light sensitivity is almost universal.

Halos and other unusual light effects can occur.

Vision can be reduced while healing.

More serious complications, which could be permanent, include:

Decreased night vision

Glare sensitivity

Worsening of the pre-operation best vision due to scar formation and other effects of the healing process

It is not uncommon for up to 10 percent of patients to require retreatment with the laser to ‘fine tune’ the desired corrective affects of the procedure.

What unique concerns about refractive surgery does the military have?

Active duty personnel who undergo this or other forms of refractive surgery may lose time from work and incur possible expenses associated with travel to a designated medical center performing the procedure.

While LASIK, a different type of refractive surgery, is quickly replacing PRK as the more common procedure performed by civilian ophthalmologists, the military must first assess its safety and applicability in operational environments before endorsing it as a procedure that is appropriate for active duty personnel.

The visual demands of personnel in the Armed Forces are often unique and more critical than day-to-day requirements for most civilians. The variety of operational environments in which service members must be capable of performing their duties requires stringent guidelines for visual function.

With more than 3,000 PRK procedures performed to date, Navy Medicine has been able to conclude that the procedure is a safe and effective alternative to the use of contacts and glasses in the vast majority of all service members, except for aviation personnel, where studies are still underway.

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